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Neurodevelopmental Outcomes of Preterm Infants With Retinopathy of Prematurity by Treatment

Girija Natarajan1, Seetha Shankaran2, Tracy L Nolen3

  • 1Department of Pediatrics, Wayne State University, Detroit, Michigan; gnatara@med.wayne.edu.

Pediatrics
|July 25, 2019
PubMed

Insights

Bevacizumab therapy for retinopathy of prematurity (ROP) in extremely preterm infants was not linked to death or neurodevelopmental impairment. However, bevacizumab was associated with increased mortality and poorer cognitive outcomes in early childhood.

Area of Science:

  • Neonatal Medicine
  • Pediatric Ophthalmology
  • Developmental Pediatrics

Background:

  • Retinopathy of prematurity (ROP) is a significant cause of visual impairment in preterm infants.
  • Treatment options for ROP include laser surgery and anti-vascular endothelial growth factor (anti-VEGF) therapy, such as bevacizumab.
  • Comparative data on long-term neurodevelopmental outcomes between these treatment modalities are limited.

Purpose of the Study:

  • To evaluate the association between bevacizumab therapy and surgical treatment for ROP with adverse outcomes in early childhood among extremely preterm infants.
  • To compare mortality and neurodevelopmental impairment (NDI) rates between bevacizumab and surgical treatment groups.

Main Methods:

  • Retrospective analysis of prospectively collected data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.
  • Inclusion of preterm infants (22-26 weeks' gestational age) treated exclusively with bevacizumab or surgery for ROP.
  • Primary outcome: death or severe NDI at 18-26 months' corrected age, assessed using Bayley Scales and Gross Motor Functional Classification Scale.

Main Results:

  • The cohort included 405 infants; 181 received bevacizumab and 224 underwent surgery.
  • No significant differences were observed in the combined outcome of death or severe NDI between the groups.
  • The bevacizumab group showed significantly higher odds of death (aOR 2.54), a cognitive score <85 (aOR 1.78), and severe motor impairment (aOR 1.73).

Conclusions:

  • While ROP treatment modality did not impact overall death or NDI, bevacizumab therapy was associated with increased mortality and poorer cognitive outcomes in early childhood.
  • These findings highlight the need for careful consideration and rigorous appraisal of ROP treatment strategies.
  • Further research is warranted to fully understand the long-term implications of bevacizumab versus surgery for ROP in extremely preterm infants.
Abstract

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